On dissection of the uterine wall during laparoscopic myomectomy

2021 ◽  
Vol 70 (5) ◽  
pp. 157-162
Author(s):  
Andrey N. Plekhanov ◽  
Vitaly F. Bezhenar ◽  
Yulia S. Shishkina ◽  
Viktor A. Linde
Keyword(s):  
Comparative Analysis ◽  
Surgical Treatment ◽  
Energy Supply ◽  
Uterine Fibroids ◽  
Operating Mode ◽  
Uterine Wall ◽  
Laparoscopic Myomectomy ◽  
Surgical Instrument ◽  
Output Frequency ◽  
Ultrasound Energy

BACKGROUND: Laparoscopic myomectomy is becoming the leading method of surgical treatment of uterine fibroids while preserving reproductive and menstrual functions. Increasingly, ultrasound energy is used to dissect the myometrium. Meanwhile, the mode and direction of the ultrasound energy supply to minimize damage to the underlying tissues have not been specified. AIM: The aim of this study was to perform a comparative analysis of the myometrium and the fibroid pseudocapsule in the projection of the myoma nodule after dissection using ultrasound energy with different initial characteristics of the surgical instrument. MATERIALS AND METHODS: For comparison, we selected two instruments with a longitudinal ultrasound energy supply with an output frequency of 80 MHz ... 2.5 GHz and 47 kHz at intermittent operating mode of 5/10 sec and one torsion instrument with a transverse ultrasound energy supply with an output frequency of 36 kHz at intermittent operating mode of 3/30 sec. RESULTS: Our study has shown that the smallest zone of irreversible changes is formed when using ultrasound energy with an output frequency of 36 kHz at intermittent operating mode of 3/30 sec with its transverse feed at 90 degrees to the blade, and the largest zone of irreversible changes is formed when using ultrasound energy with an output frequency of 47 kHz at intermittent operating mode of 5/10 sec with its longitudinal feed. CONCLUSIONS: Morphometric studies with an analysis of the depth of necrotic and necrobiotic changes in the myometrial tissue showed that from the standpoint of reproductive surgery, it is preferable to use USE with an output frequency of 36 kHz at intermittent operating mode of 3/30 sec with its transverse feed.

In vitro fertilization and embryo transfer in patients who had gone surgical treatment of uterine fibroids

2020 ◽  
Vol 19 (5) ◽  
pp. 70-76
Author(s):  
Z.U. Archegova ◽  
◽  
R.I. Shalina ◽  
G.V. Kasyanova ◽  
A.K. Rabadanova ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Embryo Transfer ◽  
Uterine Artery Embolization ◽  
Uterine Artery ◽  
Uterine Fibroids ◽  
Laparoscopic Myomectomy ◽  
Artery Embolization ◽  
Vitro Fertilization ◽  
Hysteroscopic Resection

Objective. To assess the efficacy of in vitro fertilization (IVF) and embryo transfer in patients who had gone surgical treatment for uterine fibroids using different methods. Patients and methods. This study included 133 patients who were divided into 4 groups depending on the type of treatment for uterine fibroids: no treatment (Group 1), laparotomic or laparoscopic myomectomy (Group 2), hysteroscopic resection of uterine fibroids (Group 3), and uterine artery embolization (UAE) (Group 4). Results. The total number of IVF cycles per patient was 1.8 ± 0.4 after laparoscopic myomectomy, 2.0 ± 0.4 after laparotomic myomectomy, 0.4 ± 0.2 after hysteroscopic resection, 2.1 ± 0.3 after no treatment, and 3.9 ± 0.5 after UAE. Mean number of punctures was 1.3 ± 0.4 after laparoscopic myomectomy, 1.4 ± 0.2 after laparotomic myomectomy, 2.4 ± 0.7 after hysteroscopic resection, 1.4 ± 0.7 after no treatment, and 2.1 ± 0.3 after UAE. Mean number of embryo per patient was 3.8 ± 0.1 after laparoscopic myomectomy, 3.7 ± 0.5 after laparotomic myomectomy, 2.8 ± 0.6 after hysteroscopic resection, 2.7 ± 0.2 after no treatment, and 2.2 ± 0.7 after UAE. Cumulative pregnancy rate was 28.0% after laparoscopic myomectomy, 21.0% after laparotomic myomectomy, 12.0% after hysteroscopic resection, 18.3% after no treatment, and 4.6% after UAE. The take-home baby rate was 30.0% after laparoscopic myomectomy, 23.8% after laparotomic myomectomy, 18.2% after hysteroscopic resection, 16.7% after no treatment, and 4.8% after UAE. Conclusion. The efficacy of IVF and embryo transfer after treatment for uterine fibroids is determined by numerous factors, including age, ovarian reserve, size of fibroids, methods used for treatment of uterine fibroids, time between surgical treatment and IVF and embryo transfer. In women planning pregnancy and treatment of uterine fibroids by uterine artery embolization, especially over 35 years of age, it is advisable to use IVF protocols for cryopreservation of oocytes or embryos before surgery. Key words: infertility and uterine fibroids, uterine fibroids and IVF, myomectomy and IVF, uterine artery embolization, efficiency of IVF and embryo transfer

Uterine fibroids, laparoscopic surgery and morcellation: comparative analysis of the results of organ-preserving operations

GYNECOLOGY ◽  
2021 ◽  
Vol 23 (1) ◽  
pp. 73-77
Author(s):  
Alexander A. Seregin ◽  
Anastasiia B. Nadezhdenskaia ◽  
Anna S. Makarova ◽  
Polina L. Sheshko ◽  
Anna V. Tregubova ◽  
...  
Keyword(s):  
Comparative Analysis ◽  
Blood Loss ◽  
Abdominal Cavity ◽  
Uterine Fibroids ◽  
Operation Time ◽  
Main Group ◽  
Laparoscopic Myomectomy ◽  
Control Group ◽  
Tumor Spread ◽  
Plastic Containers

Aim. To conduct a comparative analysis of the results of organ-preserving laparoscopic operations performed for uterine fibroids with the use of plastic containers for morcellation and without it. Materials and methods. We examined 57 patients with a diagnosis of uterine fibroids who were admitted to the Department of Innovative Oncology and Gynecology of the Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology for organ-preserving surgical treatment. To achieve the goal of the study, the patients were divided into the following groups: the main group 29 patients who underwent laparoscopic myomectomy and morcellation of removed nodes using plastic containers. The control group consisted of 28 patients who underwent morcellation during laparoscopic myomectomy without the use of plastic containers. Results. The duration of laparoscopic operations performed using plastic containers main group was 85.6925.87 minutes. Laparoscopic conservative myomectomies, performed without the use of limiting systems, took a slightly longer amount of time control group 88.7530.36 minutes. There were no statistically significant differences, but in the second group, more prolonged sanitation of the abdominal cavity and removal of small fragments of myomatous nodes after morcellation outside the sacs were required. Autoinfusion was used in 6 (20.69%) patients in the main group, in 7 (25%) patients in the control group. Blood transfusion was not used in any case. Average blood loss was 120.6967.50 ml in the main group, 125.0099.54 ml in the control. The duration of hospitalization in the main group was 4.661.76 days, in the control group 5.793.62 days. In the main group, histological examination revealed leiomyoma in all cases, leiomyoma was detected in 96.4% (27 patients) of cases in the control group, and leiomyosarcoma in 1 patient (3.6%). Conclusion. In all groups of patients, there was a favorable course of the postoperative period, early activation of patients. In the group of laparoscopic operations, one patient (3.6%) after morcellation of the myomatous node without the use of a plastic container was found to have leiomyosarcoma. The use of plastic containers in our study did not increase the duration of operations and did not affect the volume of blood loss, the frequency of intra- and postoperative complications. In contrast, the operation time was slightly higher among patients who were operated without the use of containers. In all likelihood, this was due to the fact that the morcellation stage itself took longer, since it was required to extract small fragments of myomatous nodes, as well as thorough and prolonged sanitation of the abdominal cavity. It should be noted that the use of plastic containers, of course, requires the development of certain skills from the surgeon, taking less and less time in parallel with the learning curve. Of course, further studies are required to assess the risk of tumor spread in patients undergoing surgery using plastic containers, but preliminary data indicate that ablastic morcellation can and should be used in organ-preserving surgery for uterine myoma.

Cytological substantiation of application of vacuum therapy in combustiology

2021 ◽  
Vol 179 (6) ◽  
pp. 44-49
Author(s):  
S. B. Bogdanov ◽  
D. N. Marchenko ◽  
K. C. Pavlyk ◽  
O. V. Gospirovish ◽  
E. A. Artemova ◽  
...  
Keyword(s):  
Comparative Analysis ◽  
Surgical Treatment ◽  
Cytological Study ◽  
Scientific Research Institute ◽  
Vacuum Therapy ◽  
Cytological Analysis ◽  
Burn Wound ◽  
Burn Wounds ◽  
Healing Wounds ◽  
Clinic Hospital

The OBJECTIVE was to perform a comparative cytological analysis of the wound exudate in healing wounds during autodermoplasty on a granulating burn wound with and without vacuum therapy.METHODS AND MATERIALS. The article presents the results of the cytological study substantiated the use of vacuum therapy in combustiology. The comparative analysis was performed in 2 groups of patients. The first group consisted of patients with granulating burn wounds, who underwent surgical treatment with vacuum therapy. The second group consisted of patients who underwent surgical treatment without vacuum therapy. In both groups, the complex of surgical treatment included autodermoplasty on a granulating burn wound. All the patients were treated in the Burn Department of the «Scientific research institute – Ochapovsky regional clinic hospital № 1».RESULTS. The application of vacuum-associated dressings in the surgical treatment of patients in burn hospitals helps to reduce the time of graft retention in the plasty of granulating burn wound, decrease the number of dressings and the amount of dressing material, reduce the time of treatment of patients.CONCLUSION. The obtained cytological results allow us to justify the application of vacuum therapy in the surgical treatment of granulating burn wounds.

Comparative analysis of the surgical treatment in the fracture offemoral neck.

1991 ◽  
Vol 4 (2) ◽  
pp. 215
Author(s):  
Ki Hong Choi ◽  
Chung Nam Kang ◽  
Jin Man Wang ◽  
Kwon Jae Roh ◽  
Jin Rok Oh
Keyword(s):  
Comparative Analysis ◽  
Surgical Treatment

scholarly journals Is fibroid location associated with hemorrhage and complication rates following laparoscopic myomectomy?

2020 ◽  
Author(s):  
Kiper Aslan ◽  
Adnan Orhan ◽  
Engin Turkgeldi ◽  
Ebru Suer ◽  
Nergis Duzok ◽  
...  
Keyword(s):  
Posterior Wall ◽  
Anterior Wall ◽  
Uterine Wall ◽  
Laparoscopic Myomectomy ◽  
Complication Rates ◽  
Analgesic Requirement ◽  
Hospitalization Period ◽  
Before And After ◽  
Wall Groups ◽  
Type 3

Abstract Objective To determine whether hemorrhage and complication rates vary according location of the dominant fibroid following laparoscopic myomectomy. Background Laparoscopic myomectomy is associated with less postoperative pain, analgesic requirement, shorter hospitalization period, and less febrile complications when compared to conventional laparotomy. Despite the advantages, complications like hemorrhage, blood transfusion, bowel and urinary tract injury and conversion to laparotomy may be seen in laparoscopic myomectomy. We don’t know whether fibroid location effect these complications. Materials & Methods Women, who underwent laparoscopic myomectomy at two different tertiary academic hospitals, were analyzed retrospectively. Only women with at least one intramural fibroid (Monroe type 3, 4 or 5) were included. Patients were categorized according to localization of the dominant fibroid, i.e. anterior uterine wall, posterior uterine wall, and fundus. Change in hemoglobin levels before and after surgery, and complication rates were compared across categories. Results 219 women with mean age of 35.7 +/-6 years were included. There were 81 women with fundal fibroid, 56 with anterior wall, and 72 with posterior wall fibroid. Other 10 women with intraligamentary and isthmic fibroid were excluded. The mean fibroid diameter was 6.7 ± 2.6, 6.6 ± 2.3, and 6.7 ± 2.3 cm in the fundal, anterior and posterior groups, respectively (p=0.9). The median (25 th – 75 th percentile) changes in hemoglobin levels were 1.5 (0.8 – 2.2), 1.3 (0.6 – 2.1), and 1.3 (0.9 – 2) g/dl in fundal, anterior and posterior wall groups, respectively (p = 0.55). There were 5 (6.2%), 5 (8.9%), and 2 (2.8%) complications in fundal, anterior, and posterior wall groups, respectively (p = 0.33). Conclusion Incidence of hemorrhage or complication does not seem to vary depending on fibroid location. However, the sample size was limited, the observed values suggest that fibroid location does not affect hemorrhage and complication rates.

scholarly journals Myoma pseudocapsule - a biological and surgical structure to respect during myomectomy

2020 ◽  
Vol 148 (3-4) ◽  
pp. 236-241
Author(s):  
Andrea Tinelli ◽  
Radmila Sparic
Keyword(s):  
Surgical Treatment ◽  
Surgical Technique ◽  
Biological Process ◽  
Positive Impact ◽  
Uterine Fibroids ◽  
Reproductive Function ◽  
Muscle Scar ◽  
New Techniques ◽  
Anatomical Studies ◽  
Surgical Practice

Uterine fibroids affect almost one in two patients, causing many pelvic problems and requiring pharmacologic and surgical treatment. For many years, the importance of the fibroid was emphasized as uterine pathology, without focusing on the complex myometrial biology peripheral to fibroid. Moreover, the traditional surgical technique in fibroid removal has not been investigated for years. In recent years, on the contrary, morphological, neuroendocrine and anatomical studies have demonstrated the importance of a biological and surgical structure surrounding myoma, rich in neurotransmitters and neurofibres, the myoma pseudocapsule. This structure is formed in the womb peripheral to fibroid onset, it separates the fibroid from the myometrium and acts as a tissue regenerator after the removal of the fibroid from the uterus. The translation of scientific research on pseudocapsules into surgical practice has allowed us to identify new techniques of myomectomy, removing the myoma inside the pseudocapsule and promoting the pseudocapsules sparing surgery. All this to favor the subsequent biological process of uterine scarring and healing, by activating the neurotransmitters and neurofibres present in the myometrial fovea. The correct healing after fibroid removal restores the uterine anatomy, with a positive impact on subsequent reproductive function, reducing problems related to the muscle scar.

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